5 Types of Psoriasis: Symptoms, Locations, and Treatments

Psoriasis is a chronic skin condition that affects millions of people worldwide. There are five main types: plaque, inverse, guttate, nail, and scalp psoriasis. Each type has its own symptoms, areas it affects, and treatment methods. This guide explains each type so you can better understand and manage your symptoms or support someone who has psoriasis.

1. Plaque Psoriasis

Overview: Plaque psoriasis is the most common type of psoriasis, affecting about 80-90% of people who have the condition. It typically appears as red, inflamed patches covered with thick, silvery scales. These plaques can vary in size and sometimes merge to cover large areas of the skin.

Symptoms: The most noticeable symptoms of plaque psoriasis are red, raised patches covered with silver-white scales. Skin can become dry and cracked, sometimes leading to bleeding. Itching and soreness are common, and there may be a burning sensation in the affected areas.

Common Locations: Plaque psoriasis often appears on the elbows, knees, scalp, lower back, palms, and soles of the feet.

Causes and Triggers: Plaque psoriasis is an autoimmune condition where the immune system mistakenly attacks healthy skin cells, causing an overproduction of skin cells that leads to thickened plaques. Common triggers include stress, infections, skin injuries, and certain medications.

Treatment Options: Treatment for plaque psoriasis includes a range of options. Topical treatments like corticosteroids, vitamin D analogs, and retinoids can help reduce inflammation and slow down skin cell growth. Phototherapy, which involves using UV light, is often effective in slowing the growth of skin cells. For severe cases, systemic medications such as methotrexate may be prescribed, as they work throughout the body to affect the immune system. Biologics, which target specific parts of the immune response, can also be effective for moderate to severe cases of plaque psoriasis.

2. Guttate Psoriasis

Overview: Guttate psoriasis often affects children and young adults, appearing suddenly after a strep throat infection. The term "guttate" means "drop-like," referring to the small, dot-like lesions that spread across the skin.

Symptoms: People with guttate psoriasis develop small, red, drop-shaped spots on their skin. Unlike plaque psoriasis, the lesions are less thick and may have thinner, lighter scales. These spots can be itchy and uncomfortable.

Meier K, Schloegl A, Poddubnyy D, Ghoreschi K. Skin manifestations in spondyloarthritis. Ther Adv Musculoskelet Dis. 2020 Dec 8;12:1759720X20975915. doi: 10.1177/1759720X20975915. PMID: 33343725; PMCID: PMC7727049.

Haulrig MB, Zachariae C, Skov L. Off-Label Treatments for Pediatric Psoriasis: Lessons for the Clinic. Psoriasis (Auckl). 2021 Feb 11;11:1-20. doi: 10.2147/PTT.S268462. PMID: 33604269; PMCID: PMC7886293.

Huang YW, Tsai TF. Exacerbation of Psoriasis Following COVID-19 Vaccination: Report From a Single Center. Front Med (Lausanne). 2021 Dec 23;8:812010. doi: 10.3389/fmed.2021.812010. PMID: 35004790; PMCID: PMC8733241.

Common Locations: Guttate psoriasis usually appears on the trunk, arms, legs, and scalp.

Causes and Triggers: A strep infection is a common trigger for guttate psoriasis. Other triggers include stress, skin injuries, and certain medications. Like other forms of psoriasis, guttate psoriasis results from an immune response gone awry.

Treatment Options: Mild corticosteroids or coal tar treatments can relieve symptoms of guttate psoriasis. Phototherapy, especially UVB light therapy, is often effective for this type. In cases triggered by strep infection, antibiotics may help reduce the severity of symptoms. For severe or resistant cases, oral medications may be prescribed.

3. Inverse Psoriasis

Overview: Inverse psoriasis typically occurs in skin folds, including areas like the armpits, groin, and under the breasts. It’s often mistaken for other skin conditions such as fungal infections due to its location and appearance. Unlike plaque psoriasis, inverse psoriasis doesn’t have the thick silvery scale and appears smoother.

Symptoms: Inverse psoriasis causes smooth, red patches of inflamed skin that appear shiny rather than scaly. These areas are often painful, particularly in spots where the skin rubs together, like under the arms or between the thighs.

Common Locations: Inverse psoriasis most commonly affects the armpits, groin, under the breasts, and buttocks.

Causes and Triggers: Like other types of psoriasis, inverse psoriasis is caused by an overactive immune system. The skin folds can trap moisture, which makes these areas prone to irritation. Friction and sweating can make symptoms worse.

Treatment Options: Treatment often involves low-potency corticosteroids or vitamin D analogs to control inflammation. Antifungal or antimicrobial treatments are sometimes recommended to reduce the risk of infection in these moist, irritated areas. Non-irritating moisturizers can also help soothe the skin and reduce friction.

4. Scalp Psoriasis

Overview: Scalp psoriasis can be mild, with slight scaling, or severe, with thick plaques covering large areas. It is common for psoriasis to spread from the scalp to areas like the forehead, neck, or around the ears.

Symptoms: Scalp psoriasis causes red patches covered with thick scales on the scalp. People with this condition often experience a dry, itchy scalp, which may crack and bleed. The flakes caused by scalp psoriasis resemble dandruff, and scratching can lead to temporary hair loss.

Scalp psoriasis on forehead with red patches and silvery scales

Common Locations: Scalp psoriasis primarily affects the scalp, but it can also extend to the hairline, forehead, back of the neck, and areas around and behind the ears.

Causes and Triggers: Scalp psoriasis is typically part of plaque psoriasis and is caused by an immune response that accelerates skin cell turnover. Stress, dry weather, and certain hair care products can trigger symptoms or make them worse.

Treatment Options: Topical treatments for scalp psoriasis include medicated shampoos containing salicylic acid, coal tar, or corticosteroids, which can relieve itching and reduce scaling. Special light combs can deliver UV light to the scalp, which is effective for people with shorter hair. Systemic treatments like methotrexate or biologics may be used for severe cases. Regular moisturizing can help reduce flaking and allow treatments to penetrate the skin more effectively.

5. Nail Psoriasis

Overview: Nail psoriasis affects the fingernails and toenails, leading to noticeable changes in nail appearance. It’s one of the more challenging types to treat since nails grow slowly and are harder to reach with topical treatments.

Symptoms: Common symptoms of nail psoriasis include pitting, where small dents form on the nail surface. Discoloration, often yellow-brown, is also common, and the nails may begin to crumble or separate from the nail bed (a condition called onycholysis). Thickening of the nails can also occur, often resembling a fungal infection.

Nail Pitting

Nail Lifting Up

Pitting + Lifting

Nail Crumbling

Common Locations: Nail psoriasis can affect both fingernails and toenails.

Causes and Triggers: Nail psoriasis is often linked to psoriasis that affects the skin, particularly near the nail bed. This immune response-driven condition can be worsened by injuries to the nails.

Treatment Options: Topical treatments such as corticosteroids, vitamin D analogs, or tazarotene can be applied under the nails or to the cuticles. In severe cases, steroid injections into the nail bed can help reduce inflammation and improve nail appearance. Systemic treatments like methotrexate or biologics are sometimes used for severe nail psoriasis. Regular nail care, including keeping nails trimmed and moisturized, can reduce discomfort and prevent damage.

Onycholysis Image: Nieradko-Iwanicka B. Nail psoriasis - what a rheumatologist should know about. Reumatologia. 2017;55(1):44-47. doi: 10.5114/reum.2017.66687. Epub 2017 Mar 22. PMID: 28386142; PMCID: PMC5380772.

Nail Crumbling Image: Piraccini BM, Starace M. Optimal management of nail disease in patients with psoriasis. Psoriasis (Auckl). 2015 Jan 9;5:25-33. doi: 10.2147/PTT.S55338. PMID: 29387579; PMCID: PMC5683109.

FAQ

What type of doctor treats psoriasis?
Dermatologists are the primary doctors who treat psoriasis. In some cases, a rheumatologist may be involved if psoriatic arthritis is present.

How many types of psoriasis are there?
There are five main types of psoriasis: plaque psoriasis, guttate psoriasis, inverse psoriasis, pustular psoriasis, and erythrodermic psoriasis.

What are the different types of psoriasis?
The different types of psoriasis include:

Plaque psoriasis (the most common form)
Guttate psoriasis (small, drop-shaped lesions)
Inverse psoriasis (affecting skin folds)
Pustular psoriasis (pus-filled bumps)
Erythrodermic psoriasis (a severe, rare form causing widespread redness and scaling)

What is the most common type of psoriasis?
Plaque psoriasis is the most common type, accounting for about 80-90% of all psoriasis cases. It appears as red, scaly patches of skin.

Can you have more than one type of psoriasis?
Yes, it is possible to have more than one type of psoriasis simultaneously or at different times. For example, a person may have plaque psoriasis and develop guttate or inverse psoriasis later.

Related Topics: